Efficacy of an intercostal nerve block administered with general anesthesia in elderly patients undergoing distal gastrectomy

Abstract

Efficacy of an intercostal nerve block administered with general anesthesia in elderly patients undergoing distal gastrectomy Abstract Purpose: The purpose of this study was to evaluate the efficacy and safety of administration of an intercostal nerve block (INB) with general anesthesia to elderly patients undergoing a distal gastrectomy.Methods: Elderly patients (>65 years) undergoing selective gastrectomy were randomly assigned to three groups (n = 80): general anesthesia (Group A); general + INB anesthesia (Group B); or, general + epidural anesthesia (Group C). General anesthesia was maintained with propofol, remifentanil and cisatracurium. The mean arterial blood pressure (MAP), heart rate (HR) and C-reactive protein (CRP) levels were determined before anesthesia (T0) and at 5 min after intubation (T1), skin incision (T2), exploration of the peritoneal cavity (T3), gastrointestinal anastomosis (T4), end of operation (T5) and 10 min after extubation (T6).Results: MAP decreased at T1 in all groups (P < 0.05) and at T2, T4 and T5 in Group C (P < 0.05) and was lower in Group C than Group B at T2 and T4 (P < 0.05). There were no differences in MAP between Groups A and B or between Groups B and C. HR increased at T2 -T6 in Group A (P < 0.05) and was higher at T2 -T6 in Group B and Group C (P < 0.05). CRP levels decreased at T2 -T5 in Groups B and C (P < 0.05) and were lower in Groups B and C compared with Group A (P < 0.05). Propofol and remifentanil doses were lower in Groups B and C (P < 0.05 and P < 0.01, respectively) and patients recovered faster than in Group A (P < 0.05).Conclusion: Administration of INB with general anesthesia enhanced analgesia, led to stable hemodynamics, and reduced anaesthetic consumption and postoperative stress response. ORIGINAL RESEARCH © 2015 CIMClin Invest Med • Vol 38, no 6, December 2015 E351 As the population ages, new advances in anesthesiology and surgery have been developed to address the unique needs of elderly surgery patients [1]. In these patients, postoperative complications occur with higher frequency because of functional decline in the major organ systems and complications due to comorbid diseases. A combinatorial approach, using an epidural with general anesthesia, has been associated with a lower postoperative stress response, a reduction in the use of general anesthesia, a faster postoperative recovery rate, and optimal analgesia [2]. However, insertion of an epidural catheter is a blind technique that may result in nerve damage, infection, bleeding and other complications, thus limiting its clinical application [1][2][3]. Intercostal nerve block (INB) has significant advantages as a pain reliever, including the ability to block the production of inflammatory mediators following tissue damage and prevent these chemical mediators from acting on peripheral nerve endings to produce primary and secondary hyperalgesia and the ability to block nociception in the spinal cord [4].As an intercostal analgesia, INB offers the additional benefits of optimal analgesia, reduce...

Effects of Thoracic Paravertebral Block on Nociceptive Levels After Skin Incision During Video-Assisted Thoracoscopic Surgery

“…Several devices have been developed that use these autonomic parameters to monitor nociceptive balance during surgery under general anesthesia [4,5]. Regional anesthesia, which blocks nerve impulse transmission, reportedly suppresses autonomic responses induced by skin incision under general anesthesia [6–8]. However, the effects of regional anesthesia on nociceptive levels after skin incision have not been evaluated.…”